Assessment clinics could speed relief for patients with hip, knee, back pain

A new regional assessment system is trying to speed up the time it takes for patients in pain to see an orthopedic specialist, the latest effort to address hip and knee replacement wait times that rank among the worst in Ontario.

A new regional assessment system is trying to speed up the time it takes for patients in pain to see an orthopedic specialist, the latest effort to address hip and knee replacement wait times that rank among the worst in Ontario.

The South West Local Health Integration Network (LHIN) – the agency that allocates health care dollars in much of Southwestern Ontario, including London – is rolling out a new way to handle patients with joint pain, launching eight rapid access clinics across the region to see patients with hip, knee and lower-back pain.

“There are other programs across the province that are a little more mature, have been around a longer time, and that is what this was based off of,” said Rhonda Butler, project leader and physiotherapist.

The musculoskeletal rapid access clinic location at London Health Sciences Centre’s University Hospital is handling hip and knee assessments, while Victoria Hospital is seeing patients referred for lower back pain.

The South West LHIN has other clinic locations in Owen Sound, Wingham, Stratford, Woodstock, St. Thomas and Strathroy.

The Erie-St. Clair LHIN, which oversees health care in Chatham, Sarnia and Windsor-Essex, also has adopted the rapid access model.

In the past, a patient who went to their family doctor for knee pain may get referred to an orthopedic surgeon for assessment. But there was no way to tell which surgeons had shorter wait lists, Butler said.

Under the new system, family doctors will refer patients with hip, knee or back pain to the central intake pool. Physiotherapists or nurse practitioners will assess the patients at one of the clinic locations.

“Within about four weeks, that’s our target, you’d be seen by one of the advanced practice providers,” Butler said. “It means we get to see people a lot sooner and put them on the right path.”

There are 1,301 patients waiting for hip replacements and 2,443 patients waiting for knee replacements in the South West LHIN. Last year, 1,910 hip replacement surgeries and 2,788 knee replacement procedures were completed in the region.

The new intake system won’t directly cut the time patients in the region wait for hip and knee replacement surgery, Butler said, but it will get them assessed more quickly and give patients pain-relief strategies they can use while they’re on the wait list.

“Instead of patients waiting months and months to see a surgeon to find out they don’t need surgery, and not doing anything in the meantime, we’ll see them within four weeks and make sure they’re doing all the right things, whether they’re going through with surgery or not,” Butler said. “It’s a good first step.”

The previous Liberal government introduced the rapid assessment system. Local implementation was spearheaded by the LHINs. In February, the Progressive Conservative government announced it was dissolving the LHINs and launching smaller Ontario health teams to coordinate health care in regions of about 300,000 people.

It is unclear whether the planned health governance shake-up will have an impact on the rapid assessment clinic program.

The South West LHIN ranks the worst in Ontario for hip replacement wait times and third from the bottom for knee replacement surgeries. National statistics show the region is among the worst in all of Canada when it comes to timely access to the life-improving joint surgeries.

Patients awaiting knee replacement surgery at the Strathroy General Hospital wait an average of 150 days for their first appointment with an orthopedic surgeon, the longest in the province.

Hospitals are funded for a set number of hip and knee replacement surgeries each year. The funding allocation does not match local demand for the procedures or the number orthopedic surgeons available.

Many orthopedic surgeons in the region say they have the ability to do more hip and knee replacements but are not funded by the province to complete them.

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